- Email: [email protected]
S1156 Fatigue and Health Related Quality of Life (HRQOL) in Pediatric Inflammatory Bowel Disease (IBD)
AGA Abstracts
S1155
S1157
A Population-Based Ecological Study Identifies Population Density, Urban/ Rural Location, and Spatial Clustering As Determinants of Susceptibility to Early-Onset Inflammatory Bowel Disease in Scotland David C. Wilson, Kevin G. Pollock, Johan Van Limbergen, Emma L. Armitage, Marian C. Aldhous, Hazel E. Drummond, Helen E. Ternent, Giles T. Innocent, Jack Satsangi
CT Colonography in Patients with Incomplete Conventional Colonoscopy: Evaluation of a Colon Dissection Mode (Filet View) for Virtual Colonoscopy Juergen M. Gschossmann, Hanno Hoppe, Peter Vock, Bettina Saar Background: During the last decade, virtual colonoscopy has turned into a potentially reliable alternative to established techniques for colon cancer screening. Multiple automated postprocessing tools have been developed to facilitate the time consuming analysis and to increase the diagnostic accuracy. However, an incomplete colonoscopy due to often reduced colon preparation with remaining stool and fluid artefacts continues to represent a major challenge. Aim: To evaluate A) a colon dissection mode (filet view) and B) an integrated computed assisted reading mode in patients with incomplete colonoscopy. Methods: In total, 30 patients (45-88 years, median age 63 years, 18 males, 12 females) with CT colonoscopy (CTC) were included. Fifteen patients had undergone an incomplete colonoscopy beforehand and findings of CTC were correlated with the surgical results or a followup colonoscopy (test group). A second group of 15 patients underwent CTC first, followed by complete conventional colonoscopy on the same day (control group). CTC was performed in prone and supine position using multislice computed tomography (Sensation 16, Siemens; Asteion; Toshiba). Postprocessing was performed using a specific CT postprocessing workstation (Extended BrillianceTM Workspace, Philips) equipped with 3D-colon dissection mode (filet view) as well as a computed assisted reading system. Results: In the test group, 5 carcinoma and 16 polyps >5 mm were found. In the control group, only 2 polyps >5 mm were detected. Sensitivity and specificity using the filet view was 75% (sensitivity) and 100% (specificity) in mean analyzing time of 14.2 min for the test group. In the test group, one carcinoma was missed in the filet view. For the control group, sensitivity/specificity were 83% and 100% in mean analyzing time of 10.5 min. Using multiplanar reconstruction alone in the test group, sensitivity increased to 87% (100% looking only for carcinomas) and specificity of 100%. However, analyzing time increased to 17.5 min using only multiplanar reconstruction in the test group. In the control group, sensitivity/specificity using multiplanar reconstruction reached 33% and 100% in mean analyzing time of 16 min. Computed assisted reading showed sensitivity/specificity of 57% and 62% in the test group versus 80% and 54% in the control group. Conclusion: The completely automated 3D-reconstruction mode “Filet view” is time efficient and shows a high efficacy in a well prepared colon. However, in patients with incomplete colonoscopy and poor colon preparation, additional time consuming analyzing modes are needed. Computed assisted reading can be of additional help for screening purposes.
Background and Aims - The recent increase in incidence of early-onset inflammatory bowel disease (EO IBD) and geographical variability suggest either environmental factors or geneenvironmental interactions contribute to aetiology. By use of an ecological study, we aim to describe spatial and temporal epidemiology of EO IBD in Scotland, looking at population level variations in EO IBD and in socio-demographic and environmental associations with these variations. Methods - The Scottish Hospital Discharges Linked Database followed by case note verification was used to identify all children aged less then 16 years for the diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between January 1986 and December 1995, with diagnosis of IBD by Lennard-Jones criteria (Scand J Gastro 1989;170(suppl): 2-6). Postcode sectors were used to study human population data based on the 2001 census and livestock data from the 2000 agricultural census. A binomial model was fitted to data using a generalised linear model (GLM) with case diagnosis as CD or UC. Cases of UC and CD were modelled independently using a Poisson GLM, dependent variable cases per postcode sector and independent variables human population density, cattle population density, sheep population density, deer population density, goat population density, pig population density, ratio of farms per person and 2 orthogonal axes (west-east, southnorth). Spatial scan statistic and space-time scan statistic were used to identify possible clusters in space and time. Results - 417 patients (266 (64%) CD, 151 UC) with EO IBD were included, with age ranging from 9 years to 15 years and 11 months at diagnosis. 219 (53%) were male. On the binomial model, males were significantly more likely to develop CD (OR 1.54, P<0.05). Human density was significantly protective for both CD (P <0.001) and UC (P<0.05). Farms per person (an index of rurality) was significant for CD (p<0.001) but not UC (p 0.07). Cases of UC were found more in the west than the east (P=0.07). On spatial clustering, the north-west of Scotland had higher number of UC cases (p<0.001); there were no temporal clusters and no significant space-time clusters. Summary and conclusions Higher human density is protective at the time of diagnosis of IBD. CD but not UC is more likely to develop in those living in the most rural of locations. Children and teenagers in the west of Scotland were more likely to develop UC than in the east of Scotland. We have confirmed the male predominance of EO CD. This ecological study did not show any significant effect of animal population density.
S1158 S1156 Clostridium difficile Colitis in An Inpatient Population: Value of CT in Establishing Prognosis Anil R. Balani, Gene Young Im, Paul Panzarella, Cheng Ting Lin, Rani J. Modayil, Simcha Pollack, Douglas S. Katz, James H. Grendell
Fatigue and Health Related Quality of Life (HRQOL) in Pediatric Inflammatory Bowel Disease (IBD) Seth B. Marcus, Jennifer A. Strople, Katie Neighbors, Jill Weissberg-Benchell, James W. Varni, Estella M. Alonso
Background:Clostridium difficile-associated disease (CDAD) ranges from diarrhea to lifethreatening pseudomembranous colitis, mostly associated with previous antibiotic exposure. Recent studies have shown the increasing incidence of CDAD and emergence of more virulent C. difficile strains leading to a healthcare burden of epidemic proportions and higher rates of severe disease. CT is being used extensively to evaluate and diagnose patients with CDAD, although CT findings are often variable and non-specific. Three prior studies have examined the correlation between specific CT findings and severity of clinical disease in CDAD, but have failed to find any definitive correlations. The purpose of our study is to evaluate the role of CT in determining prognosis in CDAD by correlating specific CT findings with outcomes such as ICU admission, colectomy and death. Methods: Our retrospective study analyzed 106 inpatients with CT scans performed within 7 days of (+) C. difficile toxin assay from 1/2005 to 11/2006. Clinical and laboratory parameters of these pts were reviewed. CT scans were retrospectively reviewed by a radiologist with >20 years of experience without knowledge of prior readings. Statistical analyses were performed comparing CT findings with clinical parameters and outcomes. Results: Eighty patients (75%) showed CT evidence of colitis from CDAD. The majority had pancolitis (58 [73%] of 80 pts). Other CT findings suggestive of colitis included accordion sign (29 pts [36%]), pericolonic stranding (75 pts [94%]), submucosal edema (53 pts [66%]), ascites (23 pts [29%]), bowel dilatation (61 pts [76%]) and pleural effusion (41 pts [51%]). Fifteen pts (15%) required ICU monitoring because of CDAD. Eight pts (8%) had colectomy. Death from CDAD was recorded for 10 pts (9%) and overall mortality was 20%. Ascites on CT correlated with the need for ICU monitoring because of CDAD (p < 0.001). The association between pts with accordion sign and pleural effusion on CT and the need for ICU monitoring approached statistical significance. Logistic regression analysis showed that the combination of clinical presentation (diarrhea, abdominal pain, nausea/vomiting and fever) with lab values (WBC, HCO3, BUN, Cr) at the time of CDAD diagnosis and presence of ascites on CT have predictive value for the need for ICU monitoring (p < 0.002). Conclusions: The majority of pts with CDAD have CT evidence of colitis, mostly pancolitis. The finding of ascites on CT appears to be independently correlated to the need for ICU monitoring. There may be predictive value in grouping clinical presentation, initial lab values and ascites on CT for determining prognosis in CDAD.
Fatigue is an integral component of one's quality of life and a common complaint among patients with IBD. This study examined the prevalence of fatigue and the level of HRQOL of children with IBD from the child's and parents' perspective. METHODS: Patients 10 to 17 years of age with established IBD cared for at a university center were eligible. Patients and parents completed an age-appropriate version of the Pediatric Quality of Life Inventory™ (PedsQL™), the PedsQL™ Multidimensional Fatigue Scale, the IMPACT-III Quality of Life Questionnaire and the Children's Depression Inventory: Short Version. Disease activity was determined according to the diagnosis using either the Pediatric Crohn's Disease Activity Index (PCDAI) or a Physician's Global Assessment (PGA). Results were compared to a sample of age, gender, and SES matched healthy controls. Higher scores indicate less fatigue and higher HRQOL. RESULTS: 70 children with IBD were compared with 157 controls. Patients were 55% male, 69% Caucasian, and had a mean age of 14.1 ± 2.1 years. Those with Crohn's disease (N=52) had a median PCDAI of 0 (interquartile range, 0-7.5) and 56% with ulcerative colitis (N=13) or indeterminate colitis (N=5) were in remission. Mean total IMPACT-III score was 137.7 ± 20.9. There were no significant differences in ethnicity, depressive symptoms, or BMI between patients with IBD and controls. Mean PedsQL™ Multidimensional Fatigue scores were 73.9 ± 16.8 and 82.2 ± 12.3 for patients with IBD and controls, respectively (p=0.0003). Mean PedsQL™ scores were 76.7 ± 14.2 and 85.9 ± 10.4 for patients with IBD and controls, respectively (p<0.0001). CONCLUSION: Children with IBD report more fatigue and lower HRQOL than healthy controls. Effect sizes are moderate to large suggesting differences are clinically relevant and may be targeted for intervention. PedsQL™ Multidimensional Fatigue Scale
S1159 Blood Flow Assessed By Perfusion CT Reflects Angiogenesis and Correlates with Prognostic Factors in pts with Pancreatic Endocrine Tumors Gaspard d'Assignies, Anne Couvelard, S. Bahrami, Marie Pierre Vullierme, Pascal Hammel, Philippe Lévy, Alain Sauvanet, Philippe B. Ruszniewski, Valérie Vilgrain
a
Purpose To prospectively correlate multidetector computed tomographic (CT) perfusion measurement of endocrine pancreatic tumors and tumor's microvascular density assessed by histological techniques and to determine whether perfusion CT parameters differ between various tumor's grades. Materials And Methods : Thirty six patients (15 males, 19 females;
p<0.0001, b p<0.001, c p<0.01. Effect Size=Small(0.20),Medium(0.50),Large(>0.80)
AGA Abstracts
A-190
S1155
S1157
A Population-Based Ecological Study Identifies Population Density, Urban/ Rural Location, and Spatial Clustering As Determinants of Susceptibility to Early-Onset Inflammatory Bowel Disease in Scotland David C. Wilson, Kevin G. Pollock, Johan Van Limbergen, Emma L. Armitage, Marian C. Aldhous, Hazel E. Drummond, Helen E. Ternent, Giles T. Innocent, Jack Satsangi
CT Colonography in Patients with Incomplete Conventional Colonoscopy: Evaluation of a Colon Dissection Mode (Filet View) for Virtual Colonoscopy Juergen M. Gschossmann, Hanno Hoppe, Peter Vock, Bettina Saar Background: During the last decade, virtual colonoscopy has turned into a potentially reliable alternative to established techniques for colon cancer screening. Multiple automated postprocessing tools have been developed to facilitate the time consuming analysis and to increase the diagnostic accuracy. However, an incomplete colonoscopy due to often reduced colon preparation with remaining stool and fluid artefacts continues to represent a major challenge. Aim: To evaluate A) a colon dissection mode (filet view) and B) an integrated computed assisted reading mode in patients with incomplete colonoscopy. Methods: In total, 30 patients (45-88 years, median age 63 years, 18 males, 12 females) with CT colonoscopy (CTC) were included. Fifteen patients had undergone an incomplete colonoscopy beforehand and findings of CTC were correlated with the surgical results or a followup colonoscopy (test group). A second group of 15 patients underwent CTC first, followed by complete conventional colonoscopy on the same day (control group). CTC was performed in prone and supine position using multislice computed tomography (Sensation 16, Siemens; Asteion; Toshiba). Postprocessing was performed using a specific CT postprocessing workstation (Extended BrillianceTM Workspace, Philips) equipped with 3D-colon dissection mode (filet view) as well as a computed assisted reading system. Results: In the test group, 5 carcinoma and 16 polyps >5 mm were found. In the control group, only 2 polyps >5 mm were detected. Sensitivity and specificity using the filet view was 75% (sensitivity) and 100% (specificity) in mean analyzing time of 14.2 min for the test group. In the test group, one carcinoma was missed in the filet view. For the control group, sensitivity/specificity were 83% and 100% in mean analyzing time of 10.5 min. Using multiplanar reconstruction alone in the test group, sensitivity increased to 87% (100% looking only for carcinomas) and specificity of 100%. However, analyzing time increased to 17.5 min using only multiplanar reconstruction in the test group. In the control group, sensitivity/specificity using multiplanar reconstruction reached 33% and 100% in mean analyzing time of 16 min. Computed assisted reading showed sensitivity/specificity of 57% and 62% in the test group versus 80% and 54% in the control group. Conclusion: The completely automated 3D-reconstruction mode “Filet view” is time efficient and shows a high efficacy in a well prepared colon. However, in patients with incomplete colonoscopy and poor colon preparation, additional time consuming analyzing modes are needed. Computed assisted reading can be of additional help for screening purposes.
Background and Aims - The recent increase in incidence of early-onset inflammatory bowel disease (EO IBD) and geographical variability suggest either environmental factors or geneenvironmental interactions contribute to aetiology. By use of an ecological study, we aim to describe spatial and temporal epidemiology of EO IBD in Scotland, looking at population level variations in EO IBD and in socio-demographic and environmental associations with these variations. Methods - The Scottish Hospital Discharges Linked Database followed by case note verification was used to identify all children aged less then 16 years for the diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between January 1986 and December 1995, with diagnosis of IBD by Lennard-Jones criteria (Scand J Gastro 1989;170(suppl): 2-6). Postcode sectors were used to study human population data based on the 2001 census and livestock data from the 2000 agricultural census. A binomial model was fitted to data using a generalised linear model (GLM) with case diagnosis as CD or UC. Cases of UC and CD were modelled independently using a Poisson GLM, dependent variable cases per postcode sector and independent variables human population density, cattle population density, sheep population density, deer population density, goat population density, pig population density, ratio of farms per person and 2 orthogonal axes (west-east, southnorth). Spatial scan statistic and space-time scan statistic were used to identify possible clusters in space and time. Results - 417 patients (266 (64%) CD, 151 UC) with EO IBD were included, with age ranging from 9 years to 15 years and 11 months at diagnosis. 219 (53%) were male. On the binomial model, males were significantly more likely to develop CD (OR 1.54, P<0.05). Human density was significantly protective for both CD (P <0.001) and UC (P<0.05). Farms per person (an index of rurality) was significant for CD (p<0.001) but not UC (p 0.07). Cases of UC were found more in the west than the east (P=0.07). On spatial clustering, the north-west of Scotland had higher number of UC cases (p<0.001); there were no temporal clusters and no significant space-time clusters. Summary and conclusions Higher human density is protective at the time of diagnosis of IBD. CD but not UC is more likely to develop in those living in the most rural of locations. Children and teenagers in the west of Scotland were more likely to develop UC than in the east of Scotland. We have confirmed the male predominance of EO CD. This ecological study did not show any significant effect of animal population density.
S1158 S1156 Clostridium difficile Colitis in An Inpatient Population: Value of CT in Establishing Prognosis Anil R. Balani, Gene Young Im, Paul Panzarella, Cheng Ting Lin, Rani J. Modayil, Simcha Pollack, Douglas S. Katz, James H. Grendell
Fatigue and Health Related Quality of Life (HRQOL) in Pediatric Inflammatory Bowel Disease (IBD) Seth B. Marcus, Jennifer A. Strople, Katie Neighbors, Jill Weissberg-Benchell, James W. Varni, Estella M. Alonso
Background:Clostridium difficile-associated disease (CDAD) ranges from diarrhea to lifethreatening pseudomembranous colitis, mostly associated with previous antibiotic exposure. Recent studies have shown the increasing incidence of CDAD and emergence of more virulent C. difficile strains leading to a healthcare burden of epidemic proportions and higher rates of severe disease. CT is being used extensively to evaluate and diagnose patients with CDAD, although CT findings are often variable and non-specific. Three prior studies have examined the correlation between specific CT findings and severity of clinical disease in CDAD, but have failed to find any definitive correlations. The purpose of our study is to evaluate the role of CT in determining prognosis in CDAD by correlating specific CT findings with outcomes such as ICU admission, colectomy and death. Methods: Our retrospective study analyzed 106 inpatients with CT scans performed within 7 days of (+) C. difficile toxin assay from 1/2005 to 11/2006. Clinical and laboratory parameters of these pts were reviewed. CT scans were retrospectively reviewed by a radiologist with >20 years of experience without knowledge of prior readings. Statistical analyses were performed comparing CT findings with clinical parameters and outcomes. Results: Eighty patients (75%) showed CT evidence of colitis from CDAD. The majority had pancolitis (58 [73%] of 80 pts). Other CT findings suggestive of colitis included accordion sign (29 pts [36%]), pericolonic stranding (75 pts [94%]), submucosal edema (53 pts [66%]), ascites (23 pts [29%]), bowel dilatation (61 pts [76%]) and pleural effusion (41 pts [51%]). Fifteen pts (15%) required ICU monitoring because of CDAD. Eight pts (8%) had colectomy. Death from CDAD was recorded for 10 pts (9%) and overall mortality was 20%. Ascites on CT correlated with the need for ICU monitoring because of CDAD (p < 0.001). The association between pts with accordion sign and pleural effusion on CT and the need for ICU monitoring approached statistical significance. Logistic regression analysis showed that the combination of clinical presentation (diarrhea, abdominal pain, nausea/vomiting and fever) with lab values (WBC, HCO3, BUN, Cr) at the time of CDAD diagnosis and presence of ascites on CT have predictive value for the need for ICU monitoring (p < 0.002). Conclusions: The majority of pts with CDAD have CT evidence of colitis, mostly pancolitis. The finding of ascites on CT appears to be independently correlated to the need for ICU monitoring. There may be predictive value in grouping clinical presentation, initial lab values and ascites on CT for determining prognosis in CDAD.
Fatigue is an integral component of one's quality of life and a common complaint among patients with IBD. This study examined the prevalence of fatigue and the level of HRQOL of children with IBD from the child's and parents' perspective. METHODS: Patients 10 to 17 years of age with established IBD cared for at a university center were eligible. Patients and parents completed an age-appropriate version of the Pediatric Quality of Life Inventory™ (PedsQL™), the PedsQL™ Multidimensional Fatigue Scale, the IMPACT-III Quality of Life Questionnaire and the Children's Depression Inventory: Short Version. Disease activity was determined according to the diagnosis using either the Pediatric Crohn's Disease Activity Index (PCDAI) or a Physician's Global Assessment (PGA). Results were compared to a sample of age, gender, and SES matched healthy controls. Higher scores indicate less fatigue and higher HRQOL. RESULTS: 70 children with IBD were compared with 157 controls. Patients were 55% male, 69% Caucasian, and had a mean age of 14.1 ± 2.1 years. Those with Crohn's disease (N=52) had a median PCDAI of 0 (interquartile range, 0-7.5) and 56% with ulcerative colitis (N=13) or indeterminate colitis (N=5) were in remission. Mean total IMPACT-III score was 137.7 ± 20.9. There were no significant differences in ethnicity, depressive symptoms, or BMI between patients with IBD and controls. Mean PedsQL™ Multidimensional Fatigue scores were 73.9 ± 16.8 and 82.2 ± 12.3 for patients with IBD and controls, respectively (p=0.0003). Mean PedsQL™ scores were 76.7 ± 14.2 and 85.9 ± 10.4 for patients with IBD and controls, respectively (p<0.0001). CONCLUSION: Children with IBD report more fatigue and lower HRQOL than healthy controls. Effect sizes are moderate to large suggesting differences are clinically relevant and may be targeted for intervention. PedsQL™ Multidimensional Fatigue Scale
S1159 Blood Flow Assessed By Perfusion CT Reflects Angiogenesis and Correlates with Prognostic Factors in pts with Pancreatic Endocrine Tumors Gaspard d'Assignies, Anne Couvelard, S. Bahrami, Marie Pierre Vullierme, Pascal Hammel, Philippe Lévy, Alain Sauvanet, Philippe B. Ruszniewski, Valérie Vilgrain
a
Purpose To prospectively correlate multidetector computed tomographic (CT) perfusion measurement of endocrine pancreatic tumors and tumor's microvascular density assessed by histological techniques and to determine whether perfusion CT parameters differ between various tumor's grades. Materials And Methods : Thirty six patients (15 males, 19 females;
p<0.0001, b p<0.001, c p<0.01. Effect Size=Small(0.20),Medium(0.50),Large(>0.80)
AGA Abstracts
A-190